Hospital at home - developing a simulation induction programme for junior doctors.

Hospital at Home (HaH) provides hospital-level care within patients' homes. With services expanding, a London HaH service embedded new junior doctor posts. Currently, gaps exist in the under- and postgraduate curriculum to develop clinical skills required to deliver care in this context.

Differences in the Oral Health of Children With Medical Complexity.

Objective: Children with medical complexity (CMC), a subgroup of children with special health care needs (CSHCN) with the most serious medical conditions and disabilities, are at risk for negative effects from poor oral health. CSHCN have high rates of poor oral health, including cavities. This study aimed to compare oral health status between CMC and CSHCN.

Respiratory Health Associated With Systemic Metal Exposure in Post-9/11 Veterans in the Department of Veterans Affairs Toxic Embedded Fragment Registry.

Objective: Adverse respiratory outcomes in post-9/11 veterans with elevated urinary metal measures and enrolled in the VA's Toxic Embedded Fragment registry were compared to those without elevated urinary metals.

Methods: Veterans completed questionnaires, underwent pulmonary physiology tests (pulmonary function and oscillometry), and provided urine samples for analysis of 13 metals. Respiratory symptoms, diagnoses, and physiology measures were compared in veterans with ≥1 urine metal elevation to those without metal elevations, adjusted for covariates, including smoking.

Carer involvement in medication adherence: carer views and experiences of facilitating medication adherence using pharmacy-filled multi-compartment medication compliance aids and other methods of adherence support-a questionnaire survey.

Introduction: Unpaid carers are an increasing proportion of the UK population. One of the many ways in which they help those they care for is assisting with medication adherence. Many older adults have medicines dispensed in pharmacy-filled multi-compartment medication compliance aids (pMCAs).

Self-reported respiratory outcomes associated with blast exposure in post 9/11 veterans.

Background: Blast lung overpressure has received interest as a cause of chronic respiratory disease in Service members who deployed in support of U.S. military operations in Southwest Asia and Afghanistan since 2001.

Effects of simulation dimensionality on laser-driven electron acceleration and photon emission in hollow microchannel targets.

Using two-dimensional (2D) and three-dimensional (3D) kinetic simulations, we examine the impact of simulation dimensionality on the laser-driven electron acceleration and the emission of collimated γ-ray beams from hollow microchannel targets. We demonstrate that the dimensionality of the simulations considerably influences the results of electron acceleration and photon generation owing to the variation of laser phase velocity in different geometries. In a 3D simulation with a cylindrical geometry, the acceleration process of electrons terminates early due to the higher phase velocity of the propagating laser fields; in contrast, 2D simulations with planar geometry tend to have prolonged electron acceleration and thus produce much more energetic electrons.

Remote Clinics During Coronavirus Disease 2019: Lessons for a Sustainable Future.

Background The coronavirus disease 2019 (COVID-19) pandemic has led to a focus on non-face-to-face (NF2F) orthopedic clinics. In this study, our aim was to establish whether NF2F clinics are sustainable according to the "triple bottom line" framework by taking into account the impact on patients, the planet, and the financial cost. Methodology This retrospective cohort study was carried out at a large district general hospital with 261 patients identified as having undergone face-to-face (F2F) or NF2F orthopedic consultations (April 2020).

Trends in Moral Injury, Distress, and Resilience Factors among Healthcare Workers at the Beginning of the COVID-19 Pandemic.

The coronavirus severe acute respiratory syndrome (COVID-19) pandemic has placed increased stress on healthcare workers (HCWs). While anxiety and post-traumatic stress have been evaluated in HCWs during previous pandemics, moral injury, a construct historically evaluated in military populations, has not. We hypothesized that the experience of moral injury and psychiatric distress among HCWs would increase over time during the pandemic and vary with resiliency factors.

Statistical analysis of trace contaminants measured in biogas.

Biogas is a renewable energy fuel that can be treated to increase purity so that the resulting "biomethane" can be injected into the natural gas pipeline grid. The trace contaminants in biogas and biomethane make up a small fraction of the total gas but they still have the potential to cause adverse health effects and pipeline corrosion. This study investigates the statistical distributions of 17 trace metals, six mercaptans, hydrogen sulfide, ammonia, and six additional trace organic compounds.

Caries risk assessment.

Caries remains the most common chronic disease affecting both children and adults in the United States. High rates of primary and secondary caries in at-risk populations result in significant lifetime costs. Dental providers should be skilled in assessing an individual patient's risk for dental caries so that effective and minimally invasive preventive strategies can be employed to address the etiology of dental caries.

Resolution of obstructive sleep apnea after mandibular distraction osteogenesis in setting of delayed tongue-lip adhesion takedown: A case report.

Rationale: There is a high prevalence of obstructive sleep apnea (OSA) in patients with Pierre Robin sequence (PRS), and treatment approaches are highly variable. One approach is a temporary tongue-lip adhesion (TLA) that acts as a temporizing measure while the mandible continues to grow and is usually taken down at 1 year of age.

Patient Concerns: Side effects of prolonged tongue-lip adhesion and optimal workup and treatment of persistent OSA in the setting of a tongue-lip adhesion.

Ketamine Infusion for Adjunct Sedation in Mechanically Ventilated Adults.

Background: Many critically ill patients receive ketamine for adjunct sedation despite a paucity of evidence on its use, dosing, and monitoring in this setting.

Objective: To describe the dosing and safety considerations of ketamine for adjunct sedation in a population of mechanically ventilated critically ill patients targeting light sedation.

Methods: We conducted a retrospective review of mechanically ventilated patients receiving continuous ketamine infusion between January 2012 and April 2016.

Effect of administration of neuromuscular blocking agents in children with severe traumatic brain injury on acute complication rates and outcomes: a secondary analysis from a randomized, controlled trial of therapeutic hypothermia.

Objective: To evaluate the association between neuromuscular blocking agents and outcome, intracranial pressure, and medical complications in children with severe traumatic brain injury.

Design: A secondary analysis of a randomized, controlled trial of therapeutic hypothermia.

Setting: Seventeen hospitals in the United States, Australia, and New Zealand.

The design and fabrication of three-chamber microscale cell culture analog devices with integrated dissolved oxygen sensors.

Whole animal testing is an essential part in evaluating the toxicological and pharmacological profiles of chemicals and pharmaceuticals, but these experiments are expensive and cumbersome. A cell culture analog (CCA) system, when used in conjunction with a physiologically based pharmacokinetic (PBPK) model, provides an in vitro supplement to animal studies and the possibility of a human surrogate for predicting human response in clinical trials. A PBPK model mathematically simulates animal metabolism by modeling the absorption, distribution, metabolism, and elimination kinetics of a chemical in interconnected tissue compartments.

Serum mepivacaine concentrations after intraoral injection in young children.

The authors measured plasma concentrations of mepivacaine in 36 children from the ages of 2 to 5 years who received dental care under light general anesthesia. The subjects were randomly assigned to receive either 2 percent mepivacaine hydrochloride with 1:20,000 levonordefrin or 3 percent mepivacaine hydrochloride without vasoconstrictor. The volume of anesthetic injected depended on the planned procedures for each patient.